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Unit VI Promoting Health in Patients With Circulatory or Perfusion Disorders
factors for CAD development. Specific cardiac enzymes are used to rule out MI. The gold standard for diagnos- ing CAD is a coronary angiogram. Medication for patients with CAD is often prescribed with the goals of (a) stop- ping the aggregation of blood components to the injured endothelium, (b) controlling factors that lead to damage of the endothelium, and (c) relieving symptoms. Percuta- neous transluminal coronary angioplasty is the procedure most commonly performed to relieve symptoms. Nursing care priorities include vital signs and physical assessment and administering medication as ordered to manage risk factors and relieve symptoms. The teaching plan includes understanding the signs of an exacerbation and managing lifestyle to limit and control risk factors. Infective endocarditis (IE) is the result of an infection of the innermost layer of the heart, the endocardium. The heart valves are the usual location for this lesion. The transthoracic echocardiogram (TTE) is the best at detect- ing the presence of vegetation. The primary treatment is IV antibiotics. Infective endocarditis unresponsive to anti- biotic therapy can be treated with valve repair or replace- ment. Nursing assessment includes monitoring vital signs, especially for the presence of fever, which can be indicative of ongoing acute infection. Teaching includes the mainte- nance of good oral hygiene and informing the healthcare provider about IE history before any dental or invasive procedure. Myocarditis is an inflammatory disease of the myocar- dium most commonly caused by viral infection or autoim- mune diseases. Clinical manifestations include chest pain, dysrhythmias, dyspnea, palpitations, syncope, and heart failure. Medical treatment focuses on the management of heart failure, dysrhythmias, and dilated cardiomyopathy that may occur due to the inflammation. Treatment also includes medications to treat the cause. Pericarditis is an inflammation of the membrane sur- rounding the heart, the pericardium. The chief clinical manifestation is pain. Tests used to diagnose pericarditis include an electrocardiogram (ECG), chest x-ray, TTE, cardiac computed tomography (CT) scan, and magnetic resonance imaging (MRI). The primary treatment is pain control with anti-inflammatories. Nursing priori- ties include pain assessment to evaluate the effectiveness of treatment and close monitoring for the complications of pericardial effusion and cardiac tamponade. Teaching priorities include distinguishing between pericarditis and heart attack to ensure the patient will seek emergency help appropriately when necessary. Valvular disease refers to either narrowing or incom- plete closure of the heart valves. In response to backward flow through the valve due to incomplete closure or resis- tance to forward flow through the stenosed valve, signs of right-sided or left-sided heart failure (HF) develop. Tests used to diagnose valvular disease include ECG, echocar- diogram, and chest x-ray. The goals of medical therapy are to manage the manifestations of HF and prevent throm- bus formation. Surgical intervention can include repair
CHAPTER SUMMARY Atherosclerosis marks the beginning of coronary artery dis- ease (CAD). The progression of plaque buildup is usually silent until occlusion of the vessel is significant enough to cause angina. Long-term effects include stable and unsta- ble angina, myocardial infarction (MI), and sudden car- diac death due to extreme obstruction of blood flow in the coronary arteries. Many of the diagnostic blood tests per- formed, such as lipid profiles, assess for the presence of risk 5. The nurse providing care for Mr. Thompson should include which of the following in the discharge teaching plan? (Select all that apply.) A. Sodium restriction B. Daily weight C. Medication teaching D. Vigorous daily exercise E. Carbohydrate counting Making Connections to Clinical Judgment 1. Recognizing Cues: What clinical findings of heart failure does Mr. Thompson have? 2. Analyzing Cues: How do the physical findings relate to the pathophysiology of heart failure? 3. Prioritizing Hypotheses: What are the highest priority findings that need to be addressed? Why? 4. Generating Solutions: What interventions would best address Mr. Thompson’s respiratory needs? 5. Taking Actions: What are the nursing intervention priorities? 6. Evaluating Outcomes: What are the findings related to fluid balance that would indicate an effective response? 2. The nurse correlates which finding with Mr. Thompson’s atrial fibrillation with a heart rate of 120 to 140 beats per minute? A. Acute decompensation requiring immediate cardioversion B. Loss of atrial kick requiring fluid resuscitation C. Increased workload of the heart requiring beta blockers D. Cardiac ischemia requiring immediate cardiac catheterization 3. The nurse understands that Mr. Thompson’s sublingual nitro- glycerin decreases chest pain through which mechanism of action? A. Dilating the coronary arteries to improve blood flow B. Decreasing preload to relieve symptoms of dyspnea C. Decreasing heart rate to decrease cardiac workload D. Converting atrial fibrillation into sinus rhythm 4. Which statement by Mr. Thompson indicates that teaching about hyperkalemia has been effective? A. “The water pill makes my potassium level high.” B. “I should eat bananas because they make my potassium go down.” C. “My liver is not working, so it holds on to the potassium.” D. “My kidneys are not working, which makes my potassium high.”
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